Journal of Clinical and Aesthetic Dermatology最新文献

Alopecia areata (AA) is an immune-mediated, nonscarring hair loss with established associations with various autoimmune conditions, including inflammatory bowel disease. The following case describes a 38-year-old White male patient with Crohn's disease who developed rapidly-progressive alopecia areata during treatment with infliximab. Despite discontinuation of infliximab and aggressive treatment with corticosteroids and tofacitinib, the patient progressed to alopecia universalis within six months. Concurrently, the patient's Crohn's disease required escalation to colectomy with ostomy placement due to inadequate response to vedolizumab. Following his colectomy, the patient continued treatment with tofacitinib and demonstrated dramatic improvement in his AA, achieving complete hair regrowth within one year and maintaining remission two years after discontinuation of all immunosuppressive therapies. This case illustrates potential mechanistic connections between alopecia areata and Crohn's disease through shared inflammatory pathways involving interferon-γ and JAK signaling. The temporal relationship between the patient's colectomy and remission of his alopecia areata suggests a gut-immune axis mechanism, where addressing the primary intestinal inflammatory source may have influenced a remote autoimmune manifestation. This case highlights the potential for targeting primary inflammatory sources to achieve broader immunologic benefits in patients with concurrent autoimmune conditions.

Background: Skin adaptogens are a class of active ingredients that can enhance human adaptation by reducing the deleterious effects of intrinsic and extrinsic stressors. Adaptogens' homeostatic actions enhance the skin's resilience, improving skin health and quality. Most of the investigated and identified adaptogens are botanicals and have relevant applications in dermatology, but their precise mechanism of action (MOA) and classification are yet to be determined.

Methods: Articles related to botanical adaptogens published within the last 20 years were obtained from the Ovid, Cochrane, and PubMed databases. Studies had to include botanicals studied topically on the skin and classified as adaptogens in the paper. The systematic search resulted in 643 articles, and after the selection process, 12 studies were chosen for the systematic review.

Results: Twelve scientific papers identified 29 topical adaptogens with capabilities of promoting skin health and cosmesis via homeostatic mechanisms. These papers reviewed the effects of topical adaptogens on photodamage, photoaging, antioxidant activity, antimicrobial activity, inflammation, metabolic activity, hormones, and regenerative effects. We propose an identification and classification system of topical adaptogens. We also list currently identified topical adaptogens in the literature and propose other potential cutaneous adaptogens.

Conclusion: We have identified 29 skin adaptogens and categorized them based on their MOA: safe, homeostatic, and multitargeted. We propose this classification system as a guide to identify and catalog topical adaptogens in dermatology.

Confluent and reticulated papillomatosis (CARP) is a rare dermatosis of uncertain etiology characterized by scaly, hyperpigmented papules that coalesce into reticulated plaques, typically affecting the upper trunk of adolescents and young adults. While oral minocycline remains the most established treatment, relapse and adverse effects often are limiting factors. We present the case of a 25-year-old male patient with an 18-month history of CARP who experienced initial improvement with oral antibiotics but discontinued systemic therapy due to side effects. The patient was successfully treated with a novel topical regimen of calcipotriene 0.005% cream daily and tretinoin 0.05% cream nightly, achieving complete clearance after 3 months of consistent use without adverse effects. This case supports the role of disordered keratinization in CARP and demonstrates that topical calcipotriene and tretinoin may offer a safe and effective treatment alternative for patients who cannot tolerate or prefer to avoid systemic antibiotics.

Recent years have witnessed significant growth in aging research due to groundbreaking discoveries in gerotherapeutics and an ever-increasing interest in longevity. Such advances beg the question, what if the physical and functional declines we associate with aging were no longer inevitable, but instead treatable through the next frontier of medical innovation? In this article, we explore the broader social and ethical implications of advancing healthspan and mitigating age-related decline. We also highlight dermatology's unique role as a catalyst of aging research, serving as a model for integrating aesthetic and functional innovations. Finally, we discuss the curious role and the ethical challenges of the aesthetic dermatology industry in the healthspan debate.

Introduction: It has been proposed that some cases of refractory atopic dermatitis are caused by an overgrowth of Malassezia spp. This study aimed to compare the colony-forming units of Malassezia spp. in patients with AD who were grouped based on their responsiveness to systemic treatment.

Methods: This prospective, cross-sectional, and comparative study was conducted in patients with AD who were treated with prednisone, cyclosporine, and methotrexate, and separated in two groups, those with and those without response to their treatments, and who had not received treatment with antifungals (topical or systemic) within the prior six months. Scoring Atopic Dermatitis (SCORAD) was determined to evaluate disease severity and therapy response. A sample of epidermal cells from the glabellar region was obtained by scraping for direct examination with methylene blue and m-Dixon agar culture in search of colony-forming units. Fisher's exact test and Mann-Whitney U test were performed to compare the groups.

Results: A total of 15 patients were included in each group. The majority of the group who were refractory to treatment were women (60%), while the non-refractory group were predominantly men (66.7%). In addition, 73.3 percent of subjects with therapeutic resistance presented fungal growth in the cultures compared to 40 percent in the non-resistant group. A significant difference was found between direct examination (p=0.000) and colony-forming units of Malassezia spp. (p=0.016) in patients with AD resistant to systemic treatment.

Conclusion: Patients with AD resistant to systemic treatment had a higher count of colony-forming units of Malassezia spp. Therefore, we propose intentionally seeking this fungus in patients with therapeutic failure to eliminate its overpopulation.

Introduction: This study highlights the experiences and clinical outcomes of Black women treated with compounded topical minoxidil (CTM), containing a steroid and retinoid, compared to over the counter (OTC) minoxidil.

Methods: A retrospective chart review included 66 Black women treated at Johns Hopkins Hospital between 2020 and 2024. Patients previously used OTC minoxidil and were currently using CTM. Data collected included patient demographics, formulation, side effects, follow-up visits, and patient-reported outcomes. Adherence was assessed at follow-up appointments based on self-reported CTM use.

Results: Of the 66 patients, 33.3 percent had traction alopecia (TA), 37.9 percent had androgenetic alopecia (AGA), and 28.8 percent had combined AGA and TA. Side effects from OTC minoxidil were reported by 21.2 percent of patients, with scalp irritation being the most common. Only 10.6 percent of patients reported side effects while using CTM, with 4.5 percent reporting scalp irritation and four reporting hypertrichosis. After receiving treatment with CTM for at least six months, patients had an overall adherence rate of 84.7 percent, compared to only 44.7 percent of patients who adhered to OTC minoxidil (p<0.001). Clinical improvement was reported by 69.6 percent of patients using CTM, compared to 45.0 percent of patients using OTC minoxidil (p<0.001).

Discussion: CTM was associated with higher adherence, fewer side effects, and clinical improvement in majority of patients treated with CTM compared to their previous OTC minoxidil use.

Limitations: This is a single institution study.

Conclusion: When treating AGA or TA in Black women, special consideration should be taken when selecting minoxidil formulation, as it may have an impact on adherence and efficacy.

Objective: Cutaneous squamous cell carcinoma (cSCC) is the second most common form of skin cancer. Advanced cSCCs encompass locally advanced cSCC (laCSCC), including primary or recurrent tumors that are not amenable to curative surgery or radiation therapy, and metastatic (locoregional or distant) cSCCs (mCSCC). With the development of immunotherapies (eg, PD-1 inhibitors), there may be an enhanced opportunity to effectively treat advanced cSCC. We aim to review the current literature on therapeutic options and outline treatment strategies to optimize care for patients with advanced cSCC.

Methods: A comprehensive literature search was completed using the keywords "advanced cutaneous squamous cell carcinoma," "treatment," "surgery," "radiotherapy," "immunotherapy," "PD1-inhibitor," "cemiplimab," and "pembrolizumab". The authors reviewed all studies and included those which addressed the topic of the review.

Results: Advanced cSCCs may not be amenable to surgery or radiotherapy due to size, location, and other aggressive features. Identifying advanced cSCCs and managing patients with multiple tumors and/or those with high tumor burden can be challenging and utilizing current evidence-based guidelines and staging systems can help selection of appropriate therapeutic options. Systemic immunotherapies such as cemiplimab and pembrolizumab have growing evidence for use as a first-line treatment for advanced cSCCs. It is important to understand the adverse event profile of these immunotherapies as utility may be limited by adverse events.

Limitations: This is a review article and is limited by the information available in the published literature. In addition, comparison between studies is limited as varying methodologies were used.

Conclusion: Advanced cSCCs can be difficult to manage and involving a multidisciplinary team is essential. For laCSCCs and mCSCCs not amenable to surgery or radiotherapy, cemiplimab and pembrolizumab can be effective therapeutic options.

Objective: We sought to evaluate changes in skin microbiome biodiversity and correlation with rosacea improvement of microencapsulated benzoyl peroxide (E-BPO) versus vehicle cream in rosacea patients in a 12-week crossover study with a no-treatment period of four weeks (Week 16).

Methods: This was a randomized, double-blind, single-center, crossover, vehicle-controlled evaluation of E-BPO on the skin microbiome in rosacea. Thirty-one participants had facial rosacea with global severity of 3 or 4 on the Investigator's Global Assessment (IGA) scale. Participants were randomly assigned to two groups. The E-BPO/vehicle group applied E-BPO for eight weeks, then vehicle for four weeks. The vehicle/E-BPO group applied vehicle for eight weeks, then E-BPO for four weeks. Clinical assessments were performed using IGA, inflammatory rosacea scale, and erythema scale. Determination of change in skin microbiome was based on facial swab sampling.

Results: Shifts in the microbiome correlated with improvements in IGA, inflammatory rosacea, and erythema. At Week 8, similar bacterial species diversity profiles were observed among all participants. After crossover of the vehicle/E-BPO group at eight weeks to E-BPO, the relative abundance of Staphylococcus epidermidis was markedly lowered, and the relative abundance of Cutibacterium acnes was slightly increased. In the E-BPO/vehicle group, the relative abundance of S. epidermidis and C. acnes at Weeks 12 and 16 remained at the level observed at Week 8.

Limitations: The study had a short duration, which may not fully capture the long-term effects and durability of E-BPO in real-world clinical practice.

Conclusion: Even after withdrawal at 16 weeks, efficacy and shifts in the skin microbiome were maintained over the duration of the study period with demonstrated clinical improvement and a well-tolerated safety profile.

Ultraviolet-induced fluorescence dermoscopy (UVFD) is a novel diagnostic and visualization technique that enhances visualization of skin dermatoses with ultraviolet (UV) light. UVFD has been used to diagnose dermatoses including bacterial and fungal infections, pigmentary disorders, and skin neoplasms. We present five cases-pitted keratolysis, porokeratosis, molluscum, biopsy site identification, and lentigo maligna-where UVFD alone, compared to traditional polarized dermoscopy (PD) or the unaided clinical exam, served as a "game-changer" in diagnosis and management. Polarized and UV images were captured using a DL5 dermatoscope coupled to a smartphone. In the cases of pitted keratolysis, porokeratosis, and molluscum, we highlight distinct patterns of fluorescence that were readily visualized with UVFD and aided efficient diagnosis, in contrast with more subtle features that were seen under PD. We also demonstrate the utility of UVFD in identification and confirmation of a prior biopsy site in a patient who presented for excision of a skin cancer. Finally, we describe the advantage of UVFD in presurgical margin delineation in a patient with lentigo maligna. In these cases, we show that UVFD facilitates prompt and accurate diagnosis, streamlines appropriate treatment, and has the capacity to reduce the need for unnecessary biopsies. Given the convenience and practicality of a dermatoscope equipped with a UV light, we propose that clinicians would benefit from the use of UVFD as a supplementary tool alongside conventional dermoscopy, rather than as a substitute.